Meet a Cayman patient

Meet a caymanian young sweet dog. His name is currently Travis (after being named Fire/Flash/Apollo) but anyway. He has been in the clinic for 3 weeks and is in intensive care. Well, not as much nowadays, but still taken half an hour of my daily routine. And is one of the most rewarding things I get to do (at least this week when I am in charge with the morning rounds:)
Travis has got a huge problem. He was tied to a tree next to a burning house/shed? something. He suffered severe burns and what you see in the following picture is an amazing healing process. When he came in his skin was still covering his body on the left side of his trunk, but was soon to be necrotic and harboured a large amount of pustular discharge underneath. 3 debridement surgeries later, daily change of bandage and a combination of silver sulfadiazine cream (and initially honey too but we gave that one up) he looks like this....

And this is me and on of my nurses, M., changing his bandages today..... You may wonder why I wear this street gang hood top on me (and having underneath a shirt and the official scub). Well, the answer lies in the climate wars. Basically, we (vets) have to spent a long time at the laptop writing the daily treatments, reports, etc. right underneath the heavy blowing air conditioning. (they) nurses walk up and down, take dogs in and out and are hot. We turn the AC up (or even off;), they turn it down. And so we have fun every day. Normally there are 1-2 vets in the hospital area and 5-6 nurses so vets are outnumbered. Sometimes we loose. Today I had to give up and put the hood on;)))

Us, posing with the pacient...

Finally, getting to work, starting up my bandage. Luckily, he is a very good and sweet dog and sits very patiently for that.

And the finished product. Tomorrow we begin again! An E collar was about to complete the picture. I will try to post some more pics as the weeks roll on;)

One night

...one plain night, or what the on call does to a human being....

I have sustained many times that being on call should be banned by law if possible, but that is just my personal opinion.

Anyway, read this...one fine night, 4.30 am, the phone rings. Vet asleep, in deep slumber. Barely conscious, reaching the phone "Hhhello, this is the emergency line, how may i help you" with a voice coming from the caves. Prr-tszt-ksick-prr comes from the other end. I try again.. "this is the emergency line"... nothing. Some distant voices far. Finally I realise it's a misguided call and I put the phone down. Then in the darkness of the room and as my neurons come back from zzz dreams, i start to worry, as i wonder if it's really an emergency, if they will call again, etc. etc.

Luckily by now more neurons awake and I realise.... I am NOT on call, the other phone is not around and that was my private phone that went off. Pffffiuuu.....
then I shut down the offending sole phone present and try to make it for another 3 hours of sleep.

My first Saturday of the year

Still rested and with fond memories of the glorious New Year's Eve, I started with my first (dreaded) Saturday of the year.
As usually, it starts bright and early at 7 o'clock and it has potential to go on until the next day at 8.30 am when you pass over the phone to the next vet in charge.
Zooming thru the morning rounds, it was 2 minutes past 8 am and there were already 2 early patients waiting in the reception area ready to be seen.
And then it went on and on. I kept seeing people and patients till 2.30 pm. By the end of the session I was mumbling and I personally couldn't understand what I was trying to comunicate with the clients. But that's another issue. Of course, as it happends, in such long hours, one gets to see everything, ranging from sheer drama (road traffic accidents, blood, shock, serious neglect) to sheer nonsence (somebody waited for an hour to see me in order to tell me how her nearly one year dog is shaking her head in a cobra the snake-like fashion the minute she tries to lay down, only this morning. Physical exam was unremarkable,the dog was great, its ears were great, I send them home with the magical words monitoring and partially crying, partially laughing within myself).
Anyway, with the ear hematoma I had to solve next and the afternoon rounds, here I was, ready to go home at 5.30 pm. Which I did...knowing very well I am on call and anything can happen, but secretly wishing it will be quiet, I mean, I had already seen half of George Town that day already...!

So I had time (how God is ironic at times:) to dress up, and actually show for a lovely dinner invitation. Friends around, sparkling conversation;) and I actually had time to eat the salmon prepared by the lovely hungarian, (God is also merciful) and so I was enjoying the dinner and the people around me when....
the unavoidable happens and the phone rings.
I fled the warm dinner within 5 minutes, as it was an emergency, some body's dog had eaten a whole box of chocolates that afternoon while the owner was missing....and for you, non-veterinarian, you must know that chocolate is toxic to our canine friends.

And turns out, the owner brings along not one, but 2 (!) Labradors, that were alone with the offending box of now-gone chocolate.
We spent 3 hours together. Step one: making them vomit. We didn't know how much time had passed since ingestion, and even which one, so it was double trouble; since we don't have here for some reason that magical injection with apomorphine that makes them sick within minutes from the injection without fail (aargh, why not?! bloody regulations) I had to resort to the good old ways. So me and the owner were soaked , first peroxide, then a really saturated salty solution that we were administering orally to 2 very resentful doggies.

Peroxide did nothing, and salty water did the trick in one of them. The other one, stubborn as a mule. N-o-t-h-i-n-g. One of my colleagues has a trick thou, which I used succesfully as my last resort. A single IV full dose of cefazolin, and antibiotic that makes them usually sick if given fast IV. Which I did, which the dog did. Turned out she wasn't even guilty and only the other one had eaten the chocs.

Step two: giving them charcoal orally to absorb the potential remaining chocolate. The owners yellow shirt turned black, I was black, the dogs were annoyed, I was resigned by then knowing I won't make it back to the dinner....

Step three: IV catheters and starting them on IV fluids.
Step four: running a chemistry panel making sure all is Ok. Well, the innocent one was OK, the other one has a few values messed up, but not massively. I hoped the IV fluids will do the trick.

Step five: adieu to the owner (who happend at least to be a very nice and cooperative owner, kudos to him), writing my bill, and off I go, nearly midnight.

The night still had one surprise in store...(ha ha)...at 4.30 am the phone rang. A dog was giving birth and the owner was scared and wondering if the delivery was going well. I asked how much time had passed since the last puppy and she said, few minutes. Ok, I said, call me back in 2 hours if another puppy is not emerging. (Oh, please God, please God, make it alright and make her not call me back...zzzzzzzzz)

The phone didn't ring till next morning around 8.30,with another case (the dog's delivery went very well) when I was quite happy to say "yes, sure, bring it to the clinic" while I was driving myself towards there but only to drop that bloody phone off.....

...and continue with a quiet and sunny relaxing Carribean Sunday of doing almost nothing and soothing my nerves:)))) and pointed with an adventure of diving right outside 7 Mile Beach till underneath the before mentioned yacht so see it's anchor and sheer size from underneath.

Oh, how we have fun as vets:)))

An unusual case

Well, imagine my puzzle a few days ago when somebody brings in 2 rescue puppies.

That in itself is not something unusual of course, especially since we collaborate so closely with the local Humane Society. But there was something else about them...




No signs of trauma, normal temperature, wagging their tails... but on sternal recumbency and over all....no muscle tonus. The consistency of a kitchen rag. And mildly dehydrated.

But...both of them??? In the same time?
They were quiet and sweet. But what is wrong?

However, before I got to panic and put the worse in front and started a more complicated treatment, Dr. Brenda was around. A very experienced practitioner, she said...Oh, it looks like a case of botulism! Maybe they both ate a rotten chicken or something!

And turns out, she was right. That's because with nothing but supportive care, they gained more strenght every passing day, and now, about a week later, they actually stand up and even started walking. By the time I get back in tomorrow they might even be running around:)

As treatment, there is a specific serum out there but we didn't have it in the clinic (well...it's the first case I have seen ever and the first one there in almost a year of work. And they seem to do dandy fine even without it). So we just gave them oral antibiotics, corrected dehydration (with fluids SC even, as they resumed quickly eating and drinking provided it was...very available) and supportive care.

And before you know it, they'll be up for adoption!

What tickled my brain lately...

Well, ... eyes. In fact lately I have had quite a few interesting opthalmologic cases which I could not refer so I had to deal with them on the spot. Thou I have consulted the diplomat specialist on one in particular.
I had 2 corneal ulcers. One was old and superficial and multiple attempts of conservative management failed. The eye kept staining with fluorescein, thru many frustrating weeks of believing it can be managed without surgery.
The other one was new and acute, a good case of desmetocel turned anterior chamber prolapse with some iris in the equation in an 8 month puppy.

I did in both a procedure, quite straightforward, which I've come to love...a 3rd eyelid flap. Technique is important, as tension applied had to be just right; owner compliance ever so important as after care as eye drops and E-collar is vital; and another new trick is the usage of own patient serum alternatively with antibiotics;

Both of them healed well after 3 weeks of the flap in place. Even the nasty iris one healed well, with a good new scar but still, healed!

Another cool one, a case of Horner's syndrome in a 5 year old male neutered Dobermann; was a bit puzzled with that but after reviewing some neuro-ophtalmology and the nervous path way (long live Predoi..NOT:) all became more clearer.

And outside of the eyes, we had a magic case of a diaphragmatic hernia in a 3 month puppy...a very nasty one that made it succesfully.... more of that in a later episode.

And 3 cheers to my current favourite drug... long live Dopram. Respiratory stimulant that is a God sent:)